He says that the organisation decided this had to be the trust's approach when implementing Cerner Millennium in 2009, which is now being used by all medical staff. "I think we were very clear from the start that we needed clinical input," he adds.

Neil Watson, director of pharmacy and medicines management at the trust, says that it was important to get all of the clinicians on board from the start.

He says: "Clinicians from all backgrounds have recognised that this is not an IT project and that to make this work it requires clinical buy-in. No matter how much you push from an IT point of view it has to be about clinical change. Actually, since we've gone live there has been a huge amount of work on the ward."

Watson argues that the NHS has made the mistake in the past of installing something and expecting everyone to just accept what has been put in place. Because of this, Newcastle decided to take a different approach.

Jardine agrees. "IT in the NHS has been seen as those guys who do the technical stuff. My view of IT is not that. I think what is unique with Newcastle is that we have lots of senior clinicians, such as Neil and his colleagues, who very much want to be part of this, and it is not left to IT to deliver something and people complain that it doesn't work. It's very much that inclusion from the outset."

The trust, which has nearly 2,000 beds and treats more than 1 million patients a year, opted to go outside of the National Programme for IT to purchase the system directly from the University of Pittsburgh Medical Centre (UPMC) for a multi-million pound sum.

"The reason we selected Cerner and moved away from the National Programme (for IT, run by the Department of Health) was really because there was a lack of traction at the time, and we felt as an organisation that it would be more beneficial to move at our own pace rather than be tied into a consortia that would have to move at the same pace," explains Jardine.

The Cerner installation, which is running in tandem with a £300m transformation programme including the upgrade of its city centre hospitals, started with what Jardine describes as a "big bang" roll out beginning with a patient administration system (PAS). He says that this was followed by a 'slow down' period so that the operational processes could be fine tuned. Since the initial installation the trust has continued to develop and add applications to the service including electronic orders for labs and radiology as well as medications for adult inpatients. A similar paediatric service will follow in the future, although there is "some work left to do" on this.

The trust sees electronic prescribing as one of the main benefits. Previously, there were problems with nurses being able to read poorly filled in prescriptions, but this is no longer an issue as the process has been standardised.

"We ultimately want to use Cerner as the core information platform so we don't have multiple silos of information across the organisation," says Jardine. "These are challenging times at the moment for the NHS in terms of reducing costs. We are looking at all these periphery systems, the smaller systems, the resource we spend on reporting, and looking at how we can centralise that."

Staff reservations

Despite these successes, some clinical staff were apprehensive about the idea of switching to an electronic system and still harbour reservations. "At the moment, there are some people that don't think it is very intuitive," says Andrew Heed, lead pharmacist. But he praises its ease of use: "Once you've done one type of order you can do another. Junior doctors are able to come into the hospital and hit the floor running."

Heed says that engagement sessions were organised before the system went live and only a small number of people were interested at first. "People who haven't done quite so well are the ones we haven't engaged because of the nature the way the project is. So at the moment we're not in out-patients, so we don't really have lots of the consultants' hands on on the system, so they're not sure, they're not convinced," he adds.

Gill Bewick, lead clinical informatics nurse, believes that this is partly down to a fear of the unknown. "Overwhelmingly, when we implemented these systems, we really did do an aggressive roll out. We were working 15 hours a day rolling this out. People would say 'We haven't slept, we're sick,' they used to hide in cupboards, I kid you not. They would do everything to avoid us," she says. "And then we'd leave and they'd go 'Is that what we've been worried about?'"

By Heed's calculations the trust delivers around 620,000 drug administrations a month, so having an electronic system in place is a must.

Watson says: "Can you imagine trying to go to wards and pulling together sets of paper notes and identifying 600,000 drug administrations to run an audit on what is happening? You could not do it."

The next step will be for the trust to gather clinical information about patients, such as why they were admitted and how long they stayed. Heed says the plan is to move away from "the great big stack of notes" that doctors fill in about patients each day. He adds: "We can just be silently updating the patient and following a pathway through, collating the information."

Newcastle also plans to work on out-patient ordering and says that in the next 12 to 18 months it will also start to make some progress on the optimisation of workflow and reducing manual overheads such as patient pamphlets.

Jardine says: "Very much tied into that is a reduction of paper, so getting results out of devices, directly in the system, stopping printing and looking at digitisation strategy for our paper and then making that information available to the people that need it."

Watson believes that the expansion of the system will be never ending. He says that he almost can't believe how far the trust has come. "You almost forget what it used to be like without (an electronic system). You've junior doctors who've never handwritten a prescription, and that's scary."